Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes

Morbidity of colostomy closure in children

The care of colostomy remains a burden to the family while complications associated with its construction and closure can be tasking to the surgeon. The aim of this study was to evaluate the outcome of colostomy closure in children in our setting. A prospective review of 31 consecutive children undergoing colostomy closure in a 6 year period. There were 18 (58.1%) boys and 13 (41.9%) girls, aged 5 months 13 years (median 3 years). The median duration of colostomy was 16 months [range, 5 days -8 years]. Indications for colostomy were anorectal malformations 16(51.6%), Hirschsprung/'s disease 10(32.3%) and others 5 (16.1%). The site of colostomy was sigmoid colon 21, transverse colon 9 and caecum one. The type of colostomy was divided 18(58.1%) and loop12 (38.7%). Intraperitoneal and extraperitoneal closure was performed in 27(87.1%) and 4(12.9%) patients, respectively. Thirteen (41.9%) patients had 16 postoperative complications; postoperative pyrexia 4 (12.9%), prolonged ileus 4 (12.9%), surgical site infection 2 (6.5%), septicaemia 2 (6.5%). Post operative complication rate was significantly associated with the status of the surgeon (p < 0.05) and duration of surgery (p < 0.05). The median duration of hospital stay was 8 days [range: 5-35 days]. There was no significant difference in hospital stay in patients with postoperative complication and thosewithout (p > 0.05). Morbidity following colostomy closure can be high, particularly when the procedure is performed by a junior trainee